03/11/2013

C Wilson CNCAOD

Dual Diagnosis workshop

Cate Wilson, CNC, Homeless Health Outreach Team

Dual Disorders/ dual diagnosis � Dual diagnosis or co-morbidity � Co occurrence of 2 or more disorders � Common to have multiple morbidities •  50-70% of people in mental health settings •  40-80% in AOD settings

Dual diagnosis heterogenic group � SU MH conditions independent � SU -> MH trigger the other � MH-> SU interact both ways � Stress -> MH -> SU outside factors � Physical illness -> stress: MH; SU � Complex interactions

Impact of Dual Diagnosis •  Significant challenges to MHS and AOD services. •  Relapse of one disorder often triggers a relapse in

the other disorder •  Poorer treatment outcomes •  overall higher rates of �  -physical problems, -homelessness-financial

criminal activity- incarceration- family breakdown- suicide-self harm- aggression- increased MH admissions- emergency services contact

Models of care-integrated care approach

� “ a chemical substance used in the treatment, cure, prevention, or diagnosis of a disease or used to otherwise enhance physical or mental well-being”

� “Recreational drugs (street drugs) target CNS and brain chemistry. They alter perception, mood and behavior”

Drug Definitions

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Why Do People use substances? •  Experimental / Rebellion •  Coping mechanism for –ve emotions, stressors,

increase self esteem •  Aid creativity, pleasure, energy •  Work study related •  Reduce boredom. •  Learned behaviour •  Cultural / social expectations

Risk factors for addiction

Barlow & Durand (2006 p 407)

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Psychoactive drugs � Produce harms and benefits � 2 major groups of harms � Toxicity (intoxication) immediate effect � Dependence- delayed effect long term drug use

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Drug use spectrum

Special considerations

�  Even small amt of substance can have severe impact on mentally ill persons Individuals with severe mental illness may consume far smaller

�  Always assess and manage all alcohol and drug use in clients with severe mental illness.

�  Early intervention for AOD use �  -prompt feedback, brief interventions,

psychoeducation or more intensive substance use interventions.

Causes of mental health problems •  1 in 5 will have a MI •  Continuum of wellness to illness model •  Mental illness vs poor work life balance •  Spectrum of disorders •  anxiety, depression (high prevalence) •  psychosis and eating disorders (low

prevalence) •  26 % of under 26 y/o mental disorder

Stress vulnerability model

Mood disorders � Mood disorders include: � �. Adjustment Disorder with depressed mood � �. Major Depressive Disorder � �. Dysthymic Disorder � �. Bipolar Disorder � �. Substance Induced Mood Disorder � �. Postnatal Depression.

Stages  of  change  model  

Integrated motivational assessment tool

Assisting families, carers & significant others �  Families support for own needs �  Mutual support groups; telephone support,

educational materials �  Provide information to families �  Emergency plan �  Others take caring role for children of users �  Young carers pursue age appropriate interests

support from school counsellors, teacher, �  trusted relative, kids help line, websites such as

http://www.youngcarers.net.au),

Treatment- overview •  TREATMENT MATCH TO CLIENT GOALS •  Substance use & mental illness needs to be

addressed •  Holistic framework •  Psychosocial issues addressed �  -social, legal, housing and welfare matters. •  Complexity of issues person may present in crisis

Treatment. •  Mental health inpatient treatment (MHA) •  Inpatient withdrawal management (detox) •  Referral to specialised withdrawal unit- HADS Fairhaven,

Riverlands, Moonyah •  Psycho-education -mental illness and substance use & how the

two inter-relate. •  Community mental health case manager, & psychiatrist •  AODS service (community based) in Miami and Southport-

specialised addiction service consisting of case managers and group workers, eg Back in Control & Adapt

•  Opioid pharmacotherapy program public programs at Miami & Southport, private prescribers GPGC

•  Private hospital Currumbin -MH/substances •  Outpatient withdrawals –GP , Biala Ground floor

Treatment. •  AOD counselling, public or private •  Better outcomes GP mental health plan psychology &

allied health •  NGO- drug arm, GCDC, Quihn, Goldbridge, •  Residential rehabilitation ( AOD, MH & DD) •  Harm reduction services –NSPs, QUIHN, sexual

health •  Recovery focused holistic care •  Youth – headspace, YHES house, GCYS •  Self help groups, AA, NA, AL ANON, Dual ANON,

Smart recovery groups,

Psychotherapy /Treatment •  Motivational enhancement techniques, MI, SOC,

integrated therapy •  Cognitive & behavioural therapies CBT, ACT •  Brief & solution focused therapies •  Gestalt, insight orientated therapies •  Family & systems therapy •  Psychologist via GP mental health plan

� Reference: � Adapted from � QLD Health dual diagnosis guidelines 2011 � NSW Clinical Guidelines- the care and

persons with comorbid mental illness and substance use problems in an acute setting 2009